Euthanasia is being pushed again in NSW. There’s a lot more that could be said, but here’s what I’m sending to my local MPs…
1st May 2013
Dear X,
I hope you are well. We pray for our parliamentary representatives regularly at church here.
I understand the Rights of the Terminally Ill Bill 2013 will soon be introduced into the Legislative Council of the NSW Parliament as a private members bill, and may also come to your attention in the Legislative Assembly.
I write to reinforce my opposition, and that of many other Christians, to euthanasia.
It is important to remember that with euthanasia, we are not talking about refusing burdensome and futile treatment, nor the administration of appropriate drugs for pain management, such as morphine. Both of those steps are legal and ethical.
Euthanasia refers to the deliberate administration of a drug, intending to cause the death of someone who is suffering. The stark reality is that it is a doctor killing a patient! (Or in the case of physician-assisted suicide, it is a doctor enabling a patient to kill him or herself).
The potential for abuse is horrific. The evidence from places like the Netherlands is of a ‘slippery-slope’, with categories widening beyond the terminally ill, even to those who do not consent, and to disabled infants. Legalizing euthanasia also introduces the potential for subtle but inappropriate pressures to be brought to bear on vulnerable persons, by relatives or an overburdened and underfunded hospital system.
By contrast, the medical evidence is that advances in palliative care have improved the symptom control of patients at the end of life, and where expertly used, suffering is minimal. I urge legislators to put their efforts into funding the improved provision of palliative care.
Legalizing euthanasia privileges individual rights in a way that threatens protection of the rights of the weak and often defenceless. As Christians, we believe God who has a special concern for the vulnerable and so we want our society to protect them.
I hope you will vote against any moves to legalize euthanasia. Thank you for your consideration on this matter.
Kind regards,
Canon Sandy Grant
Rector and Senior Canon
St Michael’s Anglican Cathedral, Wollongong
Hi Sandy – I’d be interested to see the evidence from the Netherlands re the ‘slippery slope’. Could you point me in the right direction?
I am relying on the summary of medical ethicist and palliative care specialist, Dr Megan Best. She reports that the Dutch Government’s Remmelink Report in 1991 found that approx. 1 in 3 euthanasia deaths were without patient knowledge or consent (around 1000 p.a.).
Government reviews in 1995 (Jachemsen & Keown, “Voluntary euthanasia under control? Further empirical evidence from The Netherlands”, Journal of Medical Ethics 25/1, 1999, pp16-21) and very recently (A. van der Heide et al., “End-of-life practices in the Netherlands under the Euthanasia Act”, Mew England Journal of Medicine, 356/19, 2007, pp1957-65) showed similar results.
thanks Sandy!
This paper indicates that the Dutch courts had already legitimized the death of patients who were not terminally ill before euthanasia was formally legalised parliamentarily (previously I think it was ‘de-criminalised’ informally, or something) – T. Sheldon, “Dutch argue that mental torment justifies euthanasia”, BMJ 308, 1994, pp431-32.
And this one outlines how a Dutch hospital published their guidelines on how to kill disabled newborns in 2005 – Verhagen & Sauer, “The Groningen Protocol – Euthanasia in Severely Ill Newborns”, NEJM, 352/10, 2005, pp959-62.
Over on Facebook, someone asked,
Here’s my answer: We are mostly practical utilitarians now (of an ‘egoist’ type), i.e. whatever maximises my pleasure or minimises my pain is right.
Also the mantra of rights – my individual rights, my autonomy – is king. So we scarcely stop to consider if the exercise of my (presumed) rights actually damages, or even just inadvertently undermines, the welfare of others, especially the vulnerable.
Most basically, we are practical atheists, determining to ‘know’ good and evil for ourselves. God’s Ten Commands? Bah humbug!
My friend replied,
I replied: Yes, most people have honourable motives and desires. But those desires are shaped by non-examined values, as I think we both agree.
Thanks Sandy. An excellent letter and one that I will be referring to. I’m deeply concerned about the growing ‘practical atheism’ you refer to in one of the comments above and share your thoughts on this with regards to euthanasia as well as numerous other issues.
Hi Sandy
It strikes me as odd that in your letter you object to the introduction of legislation to regulate euthanasia because of the risks of a slippery slope, yet the papers you cite regarding the Dutch experience are mostly prior to the introduction of legislation in 2002. These, of course, can tell us nothing about the consequences of such legislation. To assess such outcomes we need to, at least, compare the frequency of occurrence of the practices in question before and after the introduction of the legislation.
Of the post-legislation studies you cite, the 2007 paper in fact demonstrates a significant reduction in the frequency of euthanasia and physician assisted suicide after its enactment! The 2005 article provides no comparative frequency data. Further, the most recent major review of the literature by Rietjens et al in 2009 confirms that no slippery slope has occurred. It concludes: “The frequency of ending of life without explicit patient request did not increase over the studied years[1985-2005]. Also, there is no evidence for a higher frequency of euthanasia among the elderly, people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations.”
It seems that from these studies the Dutch experience gives no grounds to fear a slippery slope. Do you have any contrary evidence?
Cheers
Brian
I think Brian you will find this to be a classic piece from Sandy, featuring generalities, slippery slopes and reliance on 10 year old ‘evidence’ that oddly does not appear to actually support the conclusions being drawn.
Putting aside the ethical angle for a moment, I wonder how one concerned about ethics is able to take into account the practical issue of resources. I am not so certain that the palliative care held out is as marvellous as suggested. Certainly it does not take too many stories from the families of cancer sufferers to form the view that a more dignified ie quicker exit, particularly one separated from the inexorable efforts of eager medicos to sustain life until they have wrung the very last drop of cash out of the ‘patient’, would trump the actual demise many appear to suffer.
The fact is that resources in Australia are shrinking, public health is under constant budgetary pressure, and the pinnacle of a palliative care system that removes all pain is not that easy to obtain. Perhaps more so in 2013 than in 2004 when Dr Best wrote her article. Then again, as a palliative care specialist, she like all medicos are in the business of making money by providing health care until the very bitter end. So maybe her views could be taken with a grain or two of sodium.
This funding question is clearly going to become rapidly more acute in the next twenty years or so. So much so that it really would be better for all to remove their heads from the sand and look around, sniffing deeply at the roses of clarity that abound.
I note Sandy does not suggest the Anglican church fund a world’s best palliative care unit, so that the soon-to-depart might opt to have the very best of the best of the medically trained best carefully monitor their condition hour by hour, minute by minute, to ensure they live until the very last second measured out to them by God in comfort. It is a pity, given that he feels so strongly about it, that he could not persuade the controllers of the Anglican cash to finance such an institution. This would certainly give the views a stronger ring of credibility. The church would be putting its money where it’s mouth was, as it were.
Tom,
Just one quick reply to your last point by way of anecdote: my grandmother is in palliative care in one of the many Anglican Retirement Villages, a institution set up by the Anglican Diocese of Sydney and which answers to Synod. She is treated there with dignity and respect and in comfort; I cannot think of anywhere I would rather her be.
I’m happy for your grandmother, but am not sure your grandmother’s situation really relates to the resources issue.
Are you suggesting that the Anglican church caring for one grandmother means they can provide palliative care for all? I don’t quite follow.
No, simply that your rather snarky comment “I note Sandy does not suggest the Anglican church fund a world’s best palliative care unit…” is redundant: there’s 19 or so of them already across Sydney, at last count. Which is probably why Sandy didn’t feel the need to campaign for one.
Hi Sam, this method of communication is always so clumsy, so lets not go off on a tangent.
I didn’t mean that somehow the resources issue would be overcome by one or more than one Anglican funded palliative care unit. It would be nice if it were I am sure. The resources issue is a real one, and I raised it out of interest, as it was briefly touched on by Sandy. I would be interested in whether the ethical balance would ever swing away from the palliative care option if it became unaffordable and if so at what point.
For example if to afford palliative care would result directly in the death of another from whose care the resources had been diverted.
There are obviously marginal cases where the line between administering powerful painkilling drugs and hastening deatis not clear, but I am sure we have to beware of the “slippey slope”, whatever the truth of the assertions about the Netherlands might be. We live in societies where abortion for almost any reason is commonplace and anyone who complains about it is shouted down by feminists and others as thought the pro-life people are somehow the immoral ones. Therefore we have to be vigilant that this idea of killing people does not continue to spread to apply to anyone that we decide is better off dead. They may be in extreme cases, but it is a fearful thing to have a role in making or agreeing with such decisions. I would prefer that we wait until God’s time for them arrives.
O for an editing function!
David, I agree we have to take great care in handling such matters and beware of slippery slopes. The legislation in the Netherlands was intended to address such concerns by providing mechanisms to monitor and regulate practice. Without such regulation we risk active end-of-life practices continuing in an uncontrolled way with the potential development of unidentified and unwelcome practices. We also ensure that some people will be required, against their will, to continue to live when life has become intolerable to them. Legalisation of Physician Assisted Suicide addresses both these concerns; failure to legislate addresses neither.